Cargando…

A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project

BACKGROUND: Widespread voluntary medical male circumcision (VMMC) in Africa could avert an estimated 3·436 million HIV infections and 300,000 deaths over the next 10 years. Most Zambian men, however, have expressed little interest in undergoing VMMC. This study tested the effect of an intervention d...

Descripción completa

Detalles Bibliográficos
Autores principales: Weiss, Stephen M, Zulu, Robert, Jones, Deborah L, Redding, Colleen A, Cook, Ryan, Chitalu, Ndashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478609/
https://www.ncbi.nlm.nih.gov/pubmed/26120594
http://dx.doi.org/10.1016/S2352-3018(15)00042-9
_version_ 1782377913846333440
author Weiss, Stephen M
Zulu, Robert
Jones, Deborah L
Redding, Colleen A
Cook, Ryan
Chitalu, Ndashi
author_facet Weiss, Stephen M
Zulu, Robert
Jones, Deborah L
Redding, Colleen A
Cook, Ryan
Chitalu, Ndashi
author_sort Weiss, Stephen M
collection PubMed
description BACKGROUND: Widespread voluntary medical male circumcision (VMMC) in Africa could avert an estimated 3·436 million HIV infections and 300,000 deaths over the next 10 years. Most Zambian men, however, have expressed little interest in undergoing VMMC. This study tested the effect of an intervention designed to increase demand for VMMC among these “hard to reach” men. METHODS: This cluster randomized controlled trial was conducted from 2012 to 2014 in Lusaka, Zambia (HIV prevalence = 20·8%). 13 Community Health Centers (CHCs) were stratified by HIV voluntary counseling and testing (VCT) rates and patient census and randomly assigned (5:5:3) to Experimental, Control or Observation Only conditions. CHC health care providers at all 13 sites received VMMC training. Trial statisticians did not participate in randomization. 800 uncircumcised HIV-, post-VCT men, 400 per condition, were recruited; female partners were invited to participate. The primary outcome was the likelihood of VMMC by 12 months post-intervention. The trial registration is NCT 01688167. FINDINGS: 161 participants in the Experimental condition underwent VMMC as compared to 96 Control participants [adjusted odds ratio = 2·45, 95% CI = (1·24, 4·90) p = ·0166]. Post-VMMC condom use among Experimental condition participants increased compared to baseline, with no change among Control participants. No adverse events related to study participation were reported. INTERPRETATION: The Spear and Shield intervention combined with VMMC training was associated with a significant increase in the number of VMMCs performed as well as in condom use among “hard to reach” Zambian men. Results support the importance of comprehensive HIV prevention programs that increase supply of and demand for VMMC services. FUNDING: NIH/NIMH R01MH095539.
format Online
Article
Text
id pubmed-4478609
institution National Center for Biotechnology Information
language English
publishDate 2015
record_format MEDLINE/PubMed
spelling pubmed-44786092016-05-01 A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project Weiss, Stephen M Zulu, Robert Jones, Deborah L Redding, Colleen A Cook, Ryan Chitalu, Ndashi Lancet HIV Article BACKGROUND: Widespread voluntary medical male circumcision (VMMC) in Africa could avert an estimated 3·436 million HIV infections and 300,000 deaths over the next 10 years. Most Zambian men, however, have expressed little interest in undergoing VMMC. This study tested the effect of an intervention designed to increase demand for VMMC among these “hard to reach” men. METHODS: This cluster randomized controlled trial was conducted from 2012 to 2014 in Lusaka, Zambia (HIV prevalence = 20·8%). 13 Community Health Centers (CHCs) were stratified by HIV voluntary counseling and testing (VCT) rates and patient census and randomly assigned (5:5:3) to Experimental, Control or Observation Only conditions. CHC health care providers at all 13 sites received VMMC training. Trial statisticians did not participate in randomization. 800 uncircumcised HIV-, post-VCT men, 400 per condition, were recruited; female partners were invited to participate. The primary outcome was the likelihood of VMMC by 12 months post-intervention. The trial registration is NCT 01688167. FINDINGS: 161 participants in the Experimental condition underwent VMMC as compared to 96 Control participants [adjusted odds ratio = 2·45, 95% CI = (1·24, 4·90) p = ·0166]. Post-VMMC condom use among Experimental condition participants increased compared to baseline, with no change among Control participants. No adverse events related to study participation were reported. INTERPRETATION: The Spear and Shield intervention combined with VMMC training was associated with a significant increase in the number of VMMCs performed as well as in condom use among “hard to reach” Zambian men. Results support the importance of comprehensive HIV prevention programs that increase supply of and demand for VMMC services. FUNDING: NIH/NIMH R01MH095539. 2015-05-01 /pmc/articles/PMC4478609/ /pubmed/26120594 http://dx.doi.org/10.1016/S2352-3018(15)00042-9 Text en © Published by Elsevier Ltd. http://creativecommons.org/licenses/by/4.0/ This manuscript version is made available under the CC BY-NC-ND 4.0 license.
spellingShingle Article
Weiss, Stephen M
Zulu, Robert
Jones, Deborah L
Redding, Colleen A
Cook, Ryan
Chitalu, Ndashi
A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project
title A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project
title_full A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project
title_fullStr A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project
title_full_unstemmed A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project
title_short A cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in Zambia: The Spear and Shield Project
title_sort cluster randomized controlled trial to increase the availability and acceptability of voluntary medical male circumcision in zambia: the spear and shield project
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478609/
https://www.ncbi.nlm.nih.gov/pubmed/26120594
http://dx.doi.org/10.1016/S2352-3018(15)00042-9
work_keys_str_mv AT weissstephenm aclusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT zulurobert aclusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT jonesdeborahl aclusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT reddingcolleena aclusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT cookryan aclusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT chitalundashi aclusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT weissstephenm clusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT zulurobert clusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT jonesdeborahl clusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT reddingcolleena clusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT cookryan clusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject
AT chitalundashi clusterrandomizedcontrolledtrialtoincreasetheavailabilityandacceptabilityofvoluntarymedicalmalecircumcisioninzambiathespearandshieldproject